上颈椎松动术/整复术对颞下颌关节疼痛、最大开口度及压痛阈值的影响：一项系统评价与Meta分析

The Effect of Upper Cervical Mobilization/Manipulation on Temporomandibular Joint Pain, Maximal Mouth Opening, and Pressure Pain Thresholds: A Systematic Review and Meta-Analysis.

作者信息

Lam Alan C, Liddle Lane J, MacLellan Crystal L

机构信息

Department of Physical Therapy, St. John's University, Queens, NY.

Department of Psychology, University of Alberta, Edmonton, AB, Canada.

出版信息

Arch Rehabil Res Clin Transl. 2022 Nov 2;5(1):100242. doi: 10.1016/j.arrct.2022.100242. eCollection 2023 Mar.

OBJECTIVE

To evaluate the efficacy of upper cervical joint mobilization and/or manipulation on reducing pain and improving maximal mouth opening (MMO) and pressure pain thresholds (PPTs) in adults with temporomandibular joint (TMJ) dysfunction compared with sham or other intervention.

DATA SOURCES

MEDLINE, CINAHL, EMBASE, and Cochrane Library from inception to June 3, 2022, were searched.

STUDY SELECTION

Eight randomized controlled trials with 437 participants evaluating manual therapy (MT) vs sham and MT vs other intervention were included. Two reviewers independently extracted data and assessed risk of bias.

DATA EXTRACTION

Two independent reviewers extracted information about origin, number of study participants, eligibility criteria, type of intervention, and outcome measures.

DATA SYNTHESIS

Manual therapy was statistically significant in reducing pain compared with sham (mean difference [MD]: -1.93 points, 95% confidence interval [CI]: -3.61 to -0.24, =.03), and other intervention (MD: -1.03 points, 95% CI: -1.73 to -0.33, =.004), improved MMO compared with sham (MD: 2.11 mm, 95% CI: 0.26 to 3.96, =.03), and other intervention (MD: 2.25 mm, 95% CI: 1.01 to 3.48, <.001), but not statistically significant in improving PPT of masseter compared with sham (MD: 0.45 kg/cm, 95% CI: -0.21 to 1.11, =.18), and other intervention (MD: 0.42 kg/cm, 95% CI: -0.19 to 1.03, =.18), or the PPT of temporalis compared with sham (MD: 0.37 kg/cm, 95% CI: -0.03 to 0.77, =.07), and other intervention (MD: 0.43 kg/cm, 95% CI: -0.60 to 1.45, =.42).

CONCLUSION

There appears to be limited benefit of upper cervical spine MT on TMJ dysfunction, but definitive conclusions cannot be made because of heterogeneity and imprecision of treatment effects.

目的

与假干预或其他干预相比，评估上颈椎关节松动术和/或整复手法在减轻成人颞下颌关节（TMJ）功能障碍患者疼痛、改善最大开口度（MMO）和压痛阈值（PPTs）方面的疗效。

数据来源

检索了从数据库建立至2022年6月3日的MEDLINE、CINAHL、EMBASE和Cochrane图书馆。

研究选择

纳入了八项随机对照试验，共437名参与者，评估手法治疗（MT）与假干预以及MT与其他干预的效果。两名 reviewers 独立提取数据并评估偏倚风险。

数据提取

两名独立 reviewers 提取了有关研究来源、研究参与者数量、纳入标准、干预类型和结局指标的信息。

数据综合

与假干预相比，手法治疗在减轻疼痛方面具有统计学意义（平均差值[MD]：-1.93分，95%置信区间[CI]：-3.61至-0.24，P =.03），与其他干预相比也有统计学意义（MD：-1.03分，95% CI：-1.73至-0.33，P =.004）；与假干预相比，手法治疗在改善最大开口度方面有统计学意义（MD：2.11 mm，95% CI：0.26至3.96，P =.03），与其他干预相比也有统计学意义（MD：2.25 mm，95% CI：1.01至3.48，P <.001）；但与假干预相比，手法治疗在改善咬肌压痛阈值方面无统计学意义（MD：0.45 kg/cm²，95% CI：-0.21至1.11，P =.18），与其他干预相比也无统计学意义（MD：0.42 kg/cm²，95% CI：-0.19至1.03，P =.18）；与假干预相比，手法治疗在改善颞肌压痛阈值方面无统计学意义（MD：0.37 kg/cm²，95% CI：-0.03至0.77，P =.07），与其他干预相比也无统计学意义（MD：0.43 kg/cm²，95% CI：-0.60至1.45，P =.42）。